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General practice faces being 'chopped into sellable pieces'

The GPC warns pay could be hit as GPs inevitably face more competition from private firms –

Ian Cameron reports

The end of the ban on sale of goodwill has thrown up a new and potentially more damaging possibility – that private firms could pose a threat to GPs' pay by offering essential services.

This warning from the GPC follows an admission last week that GPs will inevitably face more competition from private firms for enhanced services contracts following the partial lifting of the ban.

Although a ban on trading goodwill on essential services remains, firms may increasingly see providing them as a means of 'getting patients through the door', the GPC has admitted. That way they can seek to maximise the number to whom they can provide additional and enhanced services – on which they can trade goodwill.

Such a move would chime with the Government's intention to create a competitive market in GP services as part of its patient choice policy agenda.

If companies do respond in this way and set up more convenient surgeries for commuters, for example, the move could further threaten GP pay by taking patients away from their traditional surgery.

April 1 should have marked a turning point for GPs. Forget about the Red Book: focus on new GMS. Instead, the new financial year has been marred by the profession fearing the potential competition from private firms for enhanced services contracts.

GPC negotiator Dr Laurence Buckman acknowledged that a further threat could exist if private firms prove willing to offer essential services as 'loss leaders'. He said: 'A private provider could set up essential services now, assuming PCTs are willing to contract with

them. The goodwill issue has come

in and made it more complicated.'

But he insisted few patients would up sticks and register with a surgery just because it was nearer their work.

'If every patient chose to register with a practice [near their work] we would feel threatened but the number of patients who would want to is tiny – and whether that's a GP or commercial provider makes no difference. Very few GPs will see their lists wither away.'

GPC member and Medical Practitioners Union president Dr Ron Singer said the Government had exploited the new contract's categorisation of services to erode GPs' monopoly. He said GPs should not blame the negotiators and added that the new laws were 'immediately recognised as a manipulation on the part of Government'.

He told Pulse: 'If they had brought this in six months ago they would not have got the contract through. The negotiators' explanation was that there would be an automatic renewal and the Government had just not got round to okaying it, but there was a feeling we had played into the Government's hands by helping them chop up general practice into easily sellable bits by categorising services.'

On the face of it, happily for the BMA, no one seems keen to rush headlong into exploiting the potential of the rule change. Commercial providers have so far expressed indifference to the change.

Stephen Paige, managing director of out-of-hours provider Primecare, which is already looking to expand in-hours service provision, denied the goodwill change would affect how it pursued this.

'The Department of Health want to make sure we carry on providing an important service and essentially nothing has changed,' he said. 'These regulations will keep the situation as is.'

And even the most innovative PCTs are reluctant to commission enhanced services from anyone other than GPs.

Dr Ian Rutter, chief executive of North Bradford PCT, said: 'We don't want to do anything to destroy the good relationship we have with our GPs and haven't any intention of looking to anybody else to offer these services.'

Medical accountants don't see that much money in it either. Delays in PCTs commissioning enhanced services mean no one can tell how profitable they will be, and any goodwill that builds up may just collapse when the GPs running a service cease to be involved if they sell.